S1 E25: Supporting Fertility with Kiara Marie


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Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.

Amanda: In this episode, we’re discussing an important topic that applies to all women that want to feel their best and thrive—and that’s fertility. Fertility is often made a priority when we start thinking about having kids, but truthfully optimizing your fertility means optimizing your hormones. And that’s why I invited my friend Kiara here who specializes in this in her nutrition practice to chat about it. Kiara is a Functional Fertility Nutritionist who works closely with women to teach and create sustainable lifestyle and nutrition habits to cultivate a body in life that supports healthy hormones. She has attended the Nutritional Therapy Association, Institute of Functional Nutrition and the Root Cause Protocol Institute to further her education. Kiara offers one-on-one services and an online course—Period Restoration—to help guide you through your fertility journey.

And I feel like people don’t quite…like, they think fertility and they automatically think having kids immediately, but I feel like we’re gonna change the thought process on that today.

Kiara: Yeah, definitely lots of shifts in perspective. I’m excited.

Amanda: Thanks for being here. Let’s start with your background and your own healing journey. What brought you to women’s health first of all, because obviously, that’s, like, the main focus, but why are you specifically so passionate about supporting women with their fertility?

Kiara: Good question. I think just like every other practitioner in the space, we kind of fell into it. I never thought growing up that I would become a nutritionist—that was never truly a passion of mine. Although, like, in retrospect, I’ve always been into health and wellness, like, in high school, but I feel like it was for all the wrong reasons, you know, like, diet culture and needing to lose weight, tracking calories, and all those things. And just feeling restricted with my food, thinking that if I ate a certain food I would gain weight. And that led to a lot of self-esteem issues. But still, I never thought that this would be my career. It wasn’t until I graduated college…and in college, I had a lot of digestive issues, but I didn’t think anything of them, because everyone I asked said that they had them too and they were no big deal and that it was normal.

Then all of a sudden I just couldn’t go on with my days anymore. Like, it was just so bad. I was seeing doctor after doctor, almost went to Johns Hopkins, which is like a research hospital, because I was, like, something is seriously wrong with me and no one can tell me anything. All my endoscopies were coming back normal with the exception of maybe, like, too much stomach acid and I just never found relief through the anti-spasmodic drugs that they gave me or antidepressants even and being diagnosed with IBS. It really all started with digestion. Why? I don’t know, there’s so much that goes into it. I feel like there’s a lot of emotions that go into it, the health of my parents that go into it.

I’m so excited to talk about fertility. That led me to explore my own healing. How did I get here? How do I heal things? Because I’m just so frustrated with like being handed a prescription medication or a supplement that doesn’t work. And I’ve made all these diet changes. So then I was just on Instagram, thankfully, a fellow NTP was talking about her career with the Nutritional Therapy Association. I was like, oh, my God, this is it. This is awesome, and I’m going to go for it. And that’s when I started talking about gut health and hormone health for women. Because those were my main struggles.

Recently, I made the connection with my healing. When I first started dabbling into things, I went down rabbit holes of information and really started to understand that my own health issues didn’t just happen overnight. That wasn’t just because I had a bad meal or anything like that. It really went further than that. And it all went back to my birth, and before that as well. That is what led me to pursue more of a fertility focus. Even though we know gut health and hormone health are a part of the fertility journey, I think that’s where a lot of misconceptions lie. There’s, there’s a disconnect there. So I just want to bridge that gap. And I don’t know, it’s on my heart, it’s, like, my passion to help women conceive and, you know, start creating their families. And not only that, but also have a healthy pregnancy and a healthy postpartum recovery and healthy babies. So that is kind of how I got into this space.

Amanda: That’s really cool. I had no idea that, that you almost went to Johns Hopkins and you were getting all these, like, endoscopies. How was your period? I imagine not great.

Kiara: Yeah, I mean, I was, like, kind of aware of my period for the sake of like, oh, I have an event this day, like, when is my period coming kind of thing…just to avoid having it if I could. There were months I remember where I was, like, 16 days late or if it was super heavy and clotty and, or was it, like, it was always super heavy on the first day and clotty and then the next like two or three days it was always, like, barely anything. So I was like, is this normal? But I also was like, proud to say that, like, I don’t have long periods and they’re not as bad as everyone else’s are. But, I know, I know they were not healthy just looking back at them.

Amanda: Yeah whenever the gut issues are that exacerbated, I feel like the periods are usually pretty rough.

Kiara: Oh, yeah. As nutritional therapists, we, we never attack hormones first. We always work in a North to South process, and part of that is, like, the gut. Looking at the gut and not tackling constipation, but really working from the top down. So, like, how are we digesting our food? What food are we taking in? Is there enough stomach acid? As I mentioned earlier, my GI doctor told me I had too much stomach acid and wanted to put me on PPIs, proton pump inhibitors, and that was, like, my second time going on them. And I went on them because you’re just so desperate for relief, but intuitively I knew that this was not the course of action that I needed to take. So I just stopped them on my own. I was, like, this is not going to serve me.

But yeah, any woman who’s struggling with, like, endometriosis, PCOS, hypothalamic amenorrhea, any period issue can really probably use some gut support. And I see a lot of women, I’m not sure if this has happened with you, Amanda, but they’ll come to me with period problems, and I’m like, okay, what, how’s your digestion and they’re like, oh, it’s fine. I feel like a lot of women who are entering the space may not have the body awareness that they could have. By the end of, like, our time together, because usually they’re not having 1-3 bowel movements daily that are smooth and come with ease and there are no foul odors. And no one really knows, like, what optimal digestion feels like. Are there any malabsorption issues, and then, you know, we look to leaky gut, and then improper elimination of toxins—estrogens being one of them. And it’s just, it’s a whole circle. So I never tackle hormones alone. Like, one of the tests that I run in practice is a Dutch test. And I would never, like, just run a Dutch test by itself. I feel like that is telling us what is going on, or at least a piece of the puzzle, but doesn’t really give us the how. So then that’s when we look to really optimize those foundation so that the consequences, like hormone health, can really fall into place.

Amanda: I know, I always try to explain hormones as, like, they’re the last stop on the train. So if we work on them first… Like, I honestly don’t test them immediately with a majority of my clients, unless someone is very nerdy and data-driven and they want to see it before and after. Because I’m like, this is an expensive test and it’s going to change, like, there’s no way that it’s not going to change. I also think so many people don’t know, like, I, like when someone asked, like, how’s your digestion? Most people don’t know what you mean. Like, they’re like, do I poop like that? Like, you know, like, that’s kind of all they’re really thinking about. Because I’ve had someone ask me that when I said, I think it was saying something Instagram post about healthy digestion or like, what does that mean? Like, I have bowel movements, but I don’t know if they’re healthy. So I think that’s a really good point of like the frequency, but also like, are they easy, all that kind of stuff.

And it definitely relates back to that fertility piece. When it comes to fertility, why do you think so many women struggle with this today. I see a lot of women have a hard time conceiving, even if they might feel, like, they’re, like, I feel like I’m doing everything right. But it’s still not happening.

Kiara: There’s this quote, and I can’t remember where I read it, but it’s like, “a baby’s not going to be made if stress is in the room.” And I think there are a lot of preconception protocols, and I think it’s awesome and wonderful. We can talk about the primemester in a little bit. But if we are doing all the “right things” then I think we got to take a step back and really look at what else is going on. What’s, like, internally or externally, like, what stressors are we facing? Or have we faced? And, you know, how long have we been trying for? And have we made the connection with, like, what our past history looked like? Like, did we have a past history of, like, not eating enough food? What did our periods look like just like a year ago, or maybe not even a year ago. So I find that there’s a lot of, because we want a baby, and if we’re on that journey, we’re ready for a baby now. We’re kind of just like really excited to get that journey started. And if we don’t have a baby, like, within the first time of trying it can be, I don’t know, I feel like, I mean, I haven’t tried for a baby yet. But I would think that would be kind of discouraging, especially if you’ve been working on your health for quite some time.

But I really think something I focus so much on my practice, in my practice, is emotional health and the way people respond to things and really looking at the nervous system. And, like, how you respond to daily stress in your life or, like, what is your pattern as a human and, like, how were you taking criticism and, like, all those things that, really, we don’t really think about too much. But if we have that poor nervous system response, then I would think that your HPA axis is a little off. And that can definitely impair your ability to conceive. But that does not mean you’re broken. I love what Morley Robbins would tell us in class, like, you are not broken, you are not broken. It’s such a gentle reminder when you feel like your body is just not working the way it’s supposed to.

And I think as women, like, our body is physically designed to create life, and when it’s not doing that we’re, like, I don’t know, I feel like our immediately, immediate thought process is to think that something’s wrong and we’re broken and how do I fix it? And I think that’s just your body or your mind trying to protect itself. Really taking a step back and saying, okay, what do I really need to look at? Maybe there’s something that I haven’t looked at yet. So yeah, that’s what I would say when it comes to fertility and, and talking about the primemester, there’s so much more involved than just like food, labs, and supplements. There’s a whole, like, chemical component involved, as well, as I’m sure you’ve spoken about with your clients. Like, there’s so many chemicals in today’s world, it’s insane.

Amanda: I personally think stress is just, like, destroying everyone’s health. It’s not always a stress, it’s how you respond to it, you know, like, just exactly how you were talking about your nervous system. Even when you said, like, how you take criticism, I’m like, ooh, that is such a good question for people. Because it does show you, you know, how are you handling that outside stressor? You know, can you deal with it, and I think sometimes we’re just so… Like, we’re always on our phones all day long. We’re always plugged in, we don’t spend enough time outside. I just can’t believe how many of my clients that don’t have their own business… because when you have your own business, you’re going to be working a lot, especially in the beginning—you’re going to have seasons that are busier than others. I just had no idea that people with regular jobs worked so much. I was, like, wait a minute, like, where’s the benefit? You know, like, and I know, I have, like, a very obviously, like, I feel like you have to be a certain kind of person to be an entrepreneur, but I just remember being, like, shocked and I’m, like, okay well, this is not healthy. And we can’t always combat that. You can’t always change your job, but it’s, like, then where are you going to look in other areas of your life? You know, like, what are your habits around your phone? What are your habits around sleep? Do you get outside? And it’s, it’s almost annoying how big of a piece stress is, but I just feel like the world that we live in now is more stressful.

Kiara: Mmm. Oh, my God, you said it. I’m so glad that you brought that up. Because I do speak to women where they’re, like, so stressed out with their jobs, they don’t like their jobs, and then on top of that they have so many stressors within maybe their relationship or friendships, maybe they’re lacking community. And they’re just, yeah, plugged in all the time. And they can’t remember the last time they spent, like, a day outside. And it’s like well dang, I mean, no wonder, like, your body is just, it doesn’t feel safe. Because never in our human existence have we been this chronically stressed out, whether our, like, our minds know it or not our bodies know it and feel it.

So I don’t know, I hate to say it, but my, my whole thing with my healing journey was I was working a job that I hated. I don’t know what your story is. But I was working a job 9-5, like, just straight out of college, thought that that was what I had to do. Like I said, I never thought I would be here working as an entrepreneur. I never ever thought that. I actually quit my job because I was so sick, and I hated it. So it was like, I’m gonna make this work. I bought a house, I furnished a house, I enrolled in the Nutritional Therapy Association, I just never looked back. And I somehow just made it happen. So I think when someone is on their healing journey, I really do think it takes that deep introspection and looking at your life, like, is this life serving me?

It’s, it’s not only the, the women either involved, it’s the men too. And a lot of men are having to put, you know, maybe money on the table or just like working crazy hours. And then you know, they’re trying to cultivate male friendships or whatever the case, like, they’re stressed out too. And they’re, they’re working, like, I know men who are working like 80-hour weeks. And I think it’s both of the partners involved that really need to look at their lifestyles, because it’s not just women either.

Amanda: That is such a good point. I think you did a post on male fertility, right? Because it’s, like, it’s not just, I think that’s the other piece of that fertility question, like, why do so many women struggle with fertility? I think we could even switch that to, like, couples. Why do people struggle to conceive basically, and I think that men are a huge piece of that puzzle.

Kiara: Yeah, and it’s basically just the burden was kind of placed on a woman or that’s what the norm is. But I hope we’re having conversations now where it’s like, no, we both need to be in this together. One, you have, like, support within in your relationship, you’re not alone. And two, you’re tackling it from both angles gently, like, just looking at both nutrition, lifestyles for everyone, and I think that creates a good foundation to bring a baby into the equation as well so that there’s more of like an equilibrium, if you will.

Amanda: You know, it’s something that you might not necessarily think about. It’s like, well, you know, what kind of environment are you creating for yourself? And I always, I forget, like, who said this quote, but it’s like, “you can’t heal in the same environment that made you sick” so when you said that you quit your job I was like, of course, and I’m sure that kind of like, really spurred that entire healing journey, because it, it finally allowed you to change that environment,

Kiara: Oh, yeah. And it was scary. And I think that’s why a lot of people don’t take that leap, because they’re so scared. And some, some people are, like, way further into their careers, like, they have 401Ks and all the things, like, I was really just getting started so maybe that’s what made it a little bit easier. But nonetheless, like, I still had no idea what my future was gonna look like. I felt like everything was up in the air. But I just knew with my entire heart, my entire being, a full body yes to no more of like the 9-5, waking up at like 5am so that I could have three hours to myself—because I still was very much into self-care. But that was, like, working out fasted, barely eating breakfast, and just not working with my circadian rhythm, which is another stressor that we need to look at as well in someone’s fertility journey.

So what ended up happening to me, when I started working with a functional medicine practitioner, we did a Dutch test along with like a GI map and some other tests, there was zero progesterone, like, I’m talking zero. And maybe I ovulated later on, but it did not feel like I was ovulating at all. Like, at that time in my life. I was just chronically low with DHEA, progesterone, testosterone, everything. I was just like, I almost felt dead. And my heart rate was like in the 50s I think. It was just, it was just overall pretty bad.

Amanda: And were you having a regular cycle, but you weren’t ovulating?

Kiara: I was having a period but it was kind of that light flow. I, my cramps were so bad. I remember just like crying on the floor one time just being in so much pain from my cramps. So yeah, but I was still bleeding and I wasn’t on birth control, so.

Amanda: And I think that, that’s why, like, tracking your fertile signs and your body temperature and stuff is so helpful to know. Like, am I actually ovulating. And that’s kind of like the next big piece of this is stress obviously impacts ovulation. So I definitely want you to talk about, like, how does stress impact ovulation, but even just ovulation in general, like, that’s truly what women need in order to be fertile and to have healthy hormones.

Kiara: That’s such an easy piece to overlook, because no one wants to look at their stress. They’re like, yeah, I know, I’m stressed, but tell me what to do. So as far as the types of stress go, like, I’ll just start, like, with food. Of course, like, you have to be eating a healthy diet and, like, what, what does that mean? Because it’s so nuanced these days, especially the world that we’re in. But I really like to incorporate foods that are nutrient rich. And we know that that really lies in, like, our liver and oysters and bone broths and eggs and things like that. I think that we have to really shift that conversation. Because when, I’ve had so many calls with women on like discovery calls, and they’re like I’m eating salads and I’m eating, I’m like drinking all the green juices and stuff, and I don’t know what I’m doing wrong. And not that those foods are bad. We really have to look at like the state of their guts, and usually their digestion is so wonky and so bad. And they’re eating a lot of, like, roughage, all these foods that are really rich in cellulose that their body can’t digest. And so that leaves them even more bloated and stuff. And really, I mean, they do contain nutrients. But we also have to talk about bioavailability of those nutrients as well.

One thing I really like to drink, and I think you make it too, is like a mineral broth, like, leafy greens and all those things. So it really takes, like, the minerals extracted from those greens, which we know that are important. I think when we look at food and incorporating, like, a fertility diet, really easy-to-digest foods to begin with. But that could look different for everyone.

And then from there, we take blood sugar into the equation, because blood sugar stress is huge. If we are waking up and having a big breakfast that is not balanced with, like, the carb to protein ratio, and we’re eating, like, a lot of carbs in the morning and barely any protein, which you and I both know, like, so many women are undereating protein, it’s crazy. And if they are eating protein, maybe it’s, like, not the right kind of protein. Again, going back to bioavailability. That is 100% what I see in my practice, like, so many women undereating protein. I kind of have a different story with that. I don’t know if yours is similar, but I used to track macros, like, big time in college, If It Fits Your Macros, and so I was, like, really big into the protein. So I’ve always been kind of aware of my protein intake. That plays a huge factor into blood sugar stress. And if we don’t have that under control that can lead to a lot of anxiety, mood swings, inability to respond to stress, like, emotional stuff stressors, that is something that we definitely need to take into the equation. And that can be done as simply as, like, maybe eating more frequently, incorporating the right meals and snacks and things like that. And then some women might even need to maybe monitor their blood sugar if they are responding poorly to foods. And then not eating enough, like I said with protein, but a lot of women are eating like five year olds, like, 1200 calories, 900, it’s scary. I don’t know if you’ve seen those, like, on Instagram or Pinterest or Tik Tok, but a lot of women are eating, like, grapes for breakfast after they work out. And I’m like…

Amanda: I have not seen that. That would probably give me heart palpitations.

Kiara: I can’t believe this is a thing. I feel like I’m in my bubble sometimes where I’m, like, I’m talking about blood sugar, and, like, all the women that follow me are, like, listening maybe. But there are a lot of people who are still, like, in that realm of, like, I don’t, I don’t really know what to call it, but just eat not eating enough. And then they might feel good because of stress hormones right then and there. But really years later, they might start to see some of the ramifications of eating that way, not eating enough, trickling in.

I think women, for example, if they’re struggling with hypothalamic amenorrhea, they need to increase their calorie intake. That’s usually because they’re not eating enough food, and going upwards of like the 2500 calorie range, getting maybe, like, 200 grams of carbohydrates in they might start to notice they’re gaining weight. And maybe a lot of women who were undereating, maybe they did have a background with disordered eating and that can be really tough and difficult, which is going to bring up a lot of body image concerns and things like that. So I would 100%, like, seek support if someone is going through that currently. Whether that’s working with a practitioner, finding a group, working with a therapist or something, and just navigating that whole thing, because it can be incredibly isolating, like go through it, going through it by yourself. All of that pertains to food stress. And so all of that is going to impair your, your hormones from, like, actually signaling the pituitary gland to actually have a cycle. So your body’s kind of like not receiving the energy that it needs to function optimally, and therefore you’re going to see a lot of ramifications with your cycle and your fertility.

Amanda: And I feel like long term it impacts thyroid health, which is, it is, like, the amount of… Thyroid is a huge part of my journey and especially, like, lately leading up to, like, conception and trying for a baby and everything. And I’ll definitely, like, do a whole podcast on that eventually. The inadequacy of thyroid testing of so many women struggling with suboptimal, subclinical hypothyroidism, you know, you can’t technically get it diagnosed because you’re not out of the range, but it’s still not great. So, but we’re just going to tell you, it’s normal. And I can’t tell you it’s, I mean, I think that’s a huge reason, we tried to conceive, like, a year ago and it didn’t happen. We only gave it three months, but it was, I was, like, we’re too stressed out right now. Like, this is not a good idea. You know, we just were sick of waiting, you know, we’d been together for, like, 12 years, I’m like, I just want to have your babies. This, you know, I don’t want to wait. And it didn’t work out, and I think a lot of it was stress. But I think a lot of it was thyroid health. And I just, it was difficult getting the right support and kind of figuring out all the puzzle pieces there.

Even just like medication and understanding, like, how thyroid medication impacts iodine levels. And if you don’t have great iodine and you take thyroid meds, like, it’s probably not going to turn out well. Like, it definitely didn’t for me. And that really delayed that whole conception phase for us. But all that, I mean, I have definitely under ate, like, for a very long time. And I was an athlete and I also tracked macros, just like you, and I taught a lot of people how to do it as well, which I don’t think is bad. I think honestly, for me, it probably made me eat a lot more than I would have eaten if I were not tracking. But it’s, it definitely shows up later on. And I think it’s really hard for women to see that, because they’re like, but I’m doing good now, you know, like I’m doing everything right now. And it’s, like, but what have you done for your, to you body for the last 10 years?

Kiara: Yeah you don’t make that connection unless you are working with someone or maybe you stumble across something like, oh my gosh, yeah, like, I may have done the wrong things for my body, but I did the best with what I knew at the time. And there’s that component as well, like, forgiving yourself for believing things and, you know, going full force with them. You just, you did what you thought was best. Macro counting I think truly saved me, although I was not focusing, like, on the right foods at all whatsoever. I was, like, a carb’s a carb so it’s fine. But to have, like, Skittles with, like, my steak or, something, it was so bad. I think once we make that connection, everything will start to fall into place and your body will feel safe again, because that is the entire goal—to make your body feel safe again, to make your body feel nourished. But also not forcing your body to do anything, because I think we’re in such a rush to heal. When this healing journey is, like, forever long, especially when it comes to, like, healing your thyroid.

I think stress, going back to stress, like, it plays such a huge role. But then also making sure that you’re just eating metabolically and then living in a way that’s metabolically supportive, too. There’s so many nutrients that we need to pay attention to with thyroid health, like retinol. Vitamin A is the true, I don’t know, like, it’s just, it’s such a powerful vitamin that I, I’ve never really paid attention to until the Root Cause Protocol. And I was like, wow, we all need more vitamin A. And I was actually working with someone who had, like, the most perfect retinol I’ve ever seen. And lo and behold, her diet, up until this day, like, growing up, she ate liver every single week, as a grow…, like as a child. I didn’t have that lifestyle growing up, I didn’t eat liver, but now it’s a weekly thing where I make sure I have my liver, I make sure I have my cod liver oil. But you know, all those things that we, we accumulate all those tools, like, over time, so we’re not, you see, we’re not going to heal in three months, we’re not maybe going to heal in six months. I think along the way, you’ll start to see improvements and start to notice symptoms gradually improving, but it’s not going to be this quick fix like we’re accustomed to.

Amanda: And I think that’s the hardest part of the healing journey. And whether you’re going for fertility to conceive or fertility just so that you feel your best, it can be challenging because your body is, it’s constantly compensating and it’s going to respond to things. And, you know, as you start to bring it more into balance, other things might go out of whack for a little bit and, but then they’ll come back so it…but it’s hard to accept that, because you’re kind of, like, am I doing something wrong? But it’s, like, no, your body has been through a lot.

Kiara: Yeah, it’s never linear. As much as we want it to be, like, with everything in life, things happen, shit happens. And then there’s also, like, symptoms that might worsen, like, throughout the whole healing journey, like, the healing crisis. So that’s why guidance and support can be really helpful as well.

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Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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